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An exercise tissue Doppler and strain rate imaging study of diastolic myocardial dysfunction after Kawasaki syndrome in childhood

Published online by Cambridge University Press:  01 October 2007

Raoul Arnold*
Affiliation:
Department of Paediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany Department of Paediatric Cardiology, University Hospital Freiburg, Germany
Björn Goebel
Affiliation:
1st Department of Medicine, University Hospital Jena, Germany
Herbert E. Ulmer
Affiliation:
Department of Paediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
Matthias Gorenflo
Affiliation:
Department of Paediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
Tudor C. Poerner
Affiliation:
1st Department of Medicine, University Hospital Jena, Germany
*
Correspondence to: Raoul Arnold, MD, University Hospital Freiburg, Department of Paediatric Cardiology, Mathildenstraße 1, D-79106 Freiburg, Germany. Tel: +49 761 270 4318; Fax: +49 761 270 4468; E-mail: raoul.arnold@uniklinik-freiburg.de

Abstract

Objective

Myocardial dysfunction due to coronary arterial lesions is an important complication after Kawasaki syndrome in childhood. Tissue Doppler echocardiography, and strain rate imaging, have shown their value in detecting regional myocardial dysfunction in coronary arterial disease. We aimed to examine the diagnostic value of these methods in patients with coronary arterial lesions after Kawasaki syndrome.

Methods

We assessed regional myocardial function in 17 asymptomatic patients with coronary arterial lesions. Follow-up coronary angiographies were available in all cases. Tissue Doppler echocardiography, and strain rate imaging, were performed at rest and during bicycle exercise. Examination included peak systolic and diastolic velocities, peak systolic strain and strain rate. We enrolled 17 age- and gender-matched persons to serve as a control group.

Results

Segmental left ventricular longitudinal function did not significantly differ between the groups with respect to peak systolic velocity, strain, and strain rate. Diastolic abnormalities were identified in segments supplied by coronary arteries with stenotic lesions. Peak diastolic velocity decreased significantly during exercise in those areas, from 77 plus or minus 34 to 59 plus or minus 56 millimetres per second, p smaller than 0.05. Under exercise, a peak diastolic velocity value under 90 millimetres per second enabled us to identify coronary arterial stenosis with a sensitivity of 75 percent and specificity of 64 percent.

Conclusions

After Kawasaki syndrome, diastolic impairment develops in segments supplied by stenotic coronary arteries before systolic dysfunction is detectable. Exercise tissue Doppler echocardiography has the potential to detect these subtle abnormalities, and help monitor progression of the disease.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

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References

1.Newburger, JW, Takahashi, M, Gerber, MA, et al. . Diagnosis, treatment, and long-term management of Kawasaki Disease. Circulation 2004; 110: 27472771.CrossRefGoogle ScholarPubMed
2.Burns, JC, Shike, H, Gordon, JB, Malhotra, A, Schoenwetter, M, Kawasaki, T. Sequelae of Kawasaki disease in adolescents and young adult. J Am Coll Cardiol 1996; 28: 253254.CrossRefGoogle Scholar
3.Ishiwata, S, Fuse, K, Nishiyama, S, Nakanishi, S, Watanabe, Y, Seki, A. Adult coronary artery disease secondary to Kawasaki disease in childhood. Am J Cardiol 1992; 69: 692694.CrossRefGoogle ScholarPubMed
4.Kato, H, Sugimura, T, Akagi, T, et al. . Long-term consequences of Kawasaki disease: a 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94: 13791385.CrossRefGoogle ScholarPubMed
5.Kato, H, Inoue, O, Kawasaki, T, Fujiwara, H, Watanabe, T, Toshima, H. Adult coronary artery disease probably due to childhood Kawasaki disease. Lancet 1992; 340: 11271129.CrossRefGoogle ScholarPubMed
6.Voigt, JU, Arnold, MF, Karlsson, M, et al. . Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indices in normal and infarcted myocardium. J Am Soc Echocardiogr 2000; 13: 588598.CrossRefGoogle Scholar
7.Voigt, JU, Exner, B, Schmiedehausen, K, et al. . Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003; 107: 21202126.CrossRefGoogle ScholarPubMed
8.Di Salvo, G, Eyskens, B, Claus, P, et al. . Late post-repair ventricular function in patients with origin of the left main coronary artery from the pulmonary trunk. Am J Cardiol 2004; 93: 506508.CrossRefGoogle ScholarPubMed
9.Mertens, L, Weidemann, F, Sutherland, GR. Left ventricular function before and after repair of an anomalous left coronary artery arising from the pulmonary trunk. Cardiol Young 2001; 11: 7983.CrossRefGoogle ScholarPubMed
10.Jamal, F, Kukulski, T, Strotmann, J, et al. . Quantification of the spectrum of changes in regional myocardial function during acute ischemia in closed chest pigs: an ultrasonic strain rate and strain study. J Am Soc Echocardiogr 2001; 14: 874884.CrossRefGoogle ScholarPubMed
11.Urheim, S, Edvardsen, T, Torp, H, Angelsen, B, Smiseth, OA. Myocardial strain by Doppler echocardiography: validation of a new method to quantify regional myocardial function. Circulation 2000; 102: 11581164.CrossRefGoogle ScholarPubMed
12.Voigt, JU, Lindenmeier, G, Exner, B, et al. . Incidence and characteristics of segmental postsystolic longitudinal shortening in normal, acutely ischemic, and scarred myocardium. J Am Soc Echocardiogr 2003; 16: 415423.CrossRefGoogle ScholarPubMed
13.Cheung, YF, Yung, TC, Tam, SC, Ho, MH, Chau, AK. Novel and traditional cardiovascular risk factors in children after Kawasaki disease: implications for premature atherosclerosis. J Am Coll Cardiol 2004; 43: 120124.CrossRefGoogle ScholarPubMed
14.Dahdah, NS, Fournier, A, Jaeggi, E, et al. . Segmental myocardial contractility versus perfusion in Kawasaki disease with coronary arterial aneurysm. Am J Cardiol 1999; 83: 4851.CrossRefGoogle ScholarPubMed
15.Miyagawa, M, Mochizuki, T, Murase, K, et al. . Prognostic value of DipyridamoleThallium myocardial scintigraphy in patients with Kawasaki disease. Circulation 1998; 98: 990996.CrossRefGoogle ScholarPubMed
16.Pahl, E, Sehgal, R, Chrystof, D, et al. . Feasibility of exercise stress echocardiography for the follow-up of children with coronary involvement secondary to Kawasaki disease. Circulation 1995; 91: 122128.CrossRefGoogle ScholarPubMed
17.Henein, MY, Dinarevic, S, O’Sullivan, CA, Gibson, DG, Shinebourne, EA. Exercise echocardiography in children with Kawasaki Disease: Ventricular long axis is selectively abnormal. Am J Cardiol 1998; 81: 13561359.CrossRefGoogle ScholarPubMed
18.Jamal, F, Strotmann, J, Weidemann, F, et al. . Noninvasive quantification of the contractile reserve of stunned myocardium by ultrasonic strain rate and strain. Circulation 2001; 104: 10591065.CrossRefGoogle ScholarPubMed
19.Cerqueira, MD, Weissman, NJ, Dilsizian, V, et al. . Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105: 539542.Google Scholar
20.Nesto, RW, Kowalchuk, GJ. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 1987; 57: 23C30C.CrossRefGoogle Scholar
21.Japanese Circulation Society Joint Research Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease. Pediatrics International 2005; 47: 711732.CrossRefGoogle Scholar